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The departure of Angela Braly at Wellpoint (WLP) is among many exits of health plan CEOs coming as these executives grapple with consolidation and the new order brought on by the Affordable Care Act and demands from their employer clients that they keep a lid on medical costs.

In her early years as Wellpoint’s chief executive officer, she was hailed for rising in the male dominated health insurance industry where few women rise to the top jobs in the C-suite. The highest ranking women operating health plans now are: U.S. Secretary of Health and Human Services Kathleen Sebelius; Medicare administrator Marilyn Tavenner; and Patricia Hemingway Hall, who runs Chicago-based Health Care Service Corp., the nation’s fourth-largest health plan and owner of Blue Cross and Blue Shield plans in Illinois, Texas, Oklahoma and New Mexico.

Braly brought a perspective to health insurance for women as decision-maker, a key insight given women are generally the person in U.S. households who make the calls on medical care treatment for their families.

"I do think that being a woman and a mother is an advantage in this industry, because about 70 percent of all health-care decisions are made by women," Braly, a mother of three children, told the Chicago Tribune in a 2008 interview within a year of her taking the Wellpoint CEO job.

But a series of missteps turned Wall Street and investors against Braly.

“Angela Braly took the industry lead in 2010 on the opposition of healthcare reform,” says Jeff Jonas, portfolio manager at GAMCO Investors in Rye, N.Y. “While it wasn’t a wrong position, it was very political and high profile. Wellpoint took a lot of flak for it.”

The political firestorm kept some investors like Jonas away from Wellpoint stock.

“The company’s largest state is California, which highly regulates health insurance and does so through a highly public and political process,” GAMCO’s Jonas says of Wellpoint. “So I’ve avoided them through a combination of bad geography and bad politics.”

The Affordable Care Act brings sweeping changes to the health insurance industry with most large plans like Wellpoint and their family of Blue Cross plans competing to provide quality and price-competitive benefit plans on state-regulated exchanges to offer benefits to millions of uninsured Americans when subsidies for individuals and small businesses kick in in 2014.